MEDICARE: ANDREW GRACEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	007120	GA

General Provider Information

NPI Number	:	1619782802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW GRACEN

Provider Business Mailing Address
First Line	:	5480 WILLOW POINT PKWY
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-1834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3133 MAPLE DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2505
Country	:	US
Telephone Number	:	404-220-7720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	02/12/2025

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Directions to “ ANDREW GRACEN ” Practice Location

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